Topical antimicrobials (antiseptic and antibiotics) are used in the management of wounds. However, there are challenges with their use. The concerns with antiseptics are tolerability, inactivation by organic matter and emergence of antiseptic resistance and cross-resistance between antiseptics and antibiotics. Resistance to topical antibiotics such as mupirocin and fusidic acid is increasing. The rising incidence of antibiotic resistance is also associated with an increase in multidrug resistance (MDR). Most nosocomial infections are caused by the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.), which are also becoming multidrug resistant. Hence, it is important that antiseptics exhibit antimicrobial activity against these pathogens too. 

A PubMed search was done in January 2019 for articles, published in the past five years, related to commonly used antiseptics such as povidone iodine (PVP-I), chlorhexidine gluconate, polyhexanide and octenidine and their antimicrobial efficacy, antiseptic resistance, wound healing properties and skin tolerability. Compared to other antiseptics such as chlorhexidine gluconate (CHG), polyhexanide (PHMB) and octenidine, PVP-I had the broadest spectrum of antimicrobial activity against a wider range of Gram-negative bacteria, actinobacteria, fungi and viruses, including activity against the ESKAPE pathogens including bacterial spores versus other antiseptics studied. PVP-I was highly effective at eradicating bacterial biofilms in wounds and it was effective even in the presence of blood. There has been no published data on resistance to PVP-I. On the other hand, resistance and cross resistance with chlorhexidine has been reported. PVP-I was found to promote wound healing with no cytotoxic effect and reduce the bacteria-related inflammation. PVP-I also had low allergenic properties. Unlike PVP-I, chlorhexidine exhibited allergic reactions and reduced efficacy in the presence of organic material. This article has examined the common challenges that confront us in antisepsis such as antimicrobial efficacy, antiseptic resistance, antibiotic and antiseptic cross-resistance, wound healing and tolerability. A comparison of PVP-I with other commonly used antiseptics showed that PVP-I continues to be a promising agent for the management of wounds and nosocomial infections and antisepsis.

Barreto R, et al. Int J Antimicrob Agents. 2020 Sep;56(3):106064